Pericardial Disease

Question 1

Physical exam of Chronic constrictive pericarditis

Answer 1

Normal to decreased BP

Positive Kussmaul’s sign

Pericardial knock (early diastolic sound confused with S3, opening snap)

Question 2

Signs/symptoms of acute pericarditis

Answer 2

Central sternal/parasternal aching that radiates to L trapezius ridge (irritates central diaphragm), varies with respiration/position (better sitting up, leaning forward, exhalation)

• much the same as coronary ischemia

Question 3

What tests can you use for chronic constrictuve pericarditis?

Answer 3

EKG (low voltage, non-specific T-wave changes, 1/3 afib)
CXR (small heart, clear lungs, 50% calcification)
Catheterization (equlibrium between RV/LV diastolic pressures)
CT/MRI (to visualize thickened pericardium)
Echocardiography

Question 4

Signs/symptoms of pericardial effusion with cardiac tamponade

Answer 4

Dyspnea (on exertion), orthopnea, hypotensive symptoms

Question 5

Physical exam of acute pericarditis

Answer 5

Pericardial rub [usually] with three components (systole, early + late diastole), best heard along left sternal border

Question 6

Physical exam of pericardial effusion w cardiac tamponade

Answer 6

Tachypnea, Tachycardia

Paradoxical pulse (exaggeration of what is expected)

Elevated JVP, no Kussmaul’s sign (rise in JVP on inspiration)

Question 7

Testing for acute pericarditis

Answer 7

EKG
WBC/ESR
CPK-MB
Echocardiogram

Question 8

Imaging of pericardial effusion with cardiac tamponade

Answer 8

EKG: minimal value
CXR: may show enlarged silhouette, clear lung fields
Echocardiogram: best for detection of effusion, will show other changes, diagnostic of tamponade
Right heart catheterization: diagnostic + treatment

Question 9

Findings on EKG of chronic constrictive pericarditis

Answer 9

Low voltage, non-specific T wave changes, 1/3 cases have a-fib

Question 10

What is pericardial effusion with cardiac tamponade

Answer 10

accumulation of pericardial fluid sufficient to raise pericardial pressure –> compress heart, reduce output

Question 11

What is key to diagnosis of constrictive pericarditis?

Answer 11

Cardiac catheterization shows equilibrium of left and right ventricular diastolic pressures

• -> Diastolic filling impaired in both ventricles
• —> Follow with CT/MRI to visualize thickened pericardium

Question 12

History, symptoms of constrictive pericarditis

Answer 12

Right sided congestion:
can’t expand chambers, elevated filling pressures (JVP elevated, + Kussmaul’s), stroke volume compromised, back pressure on IVC –> liver, legs edema, ascites

Question 13

abnormally large decrease (more than 10mm Hg) in systolic blood pressure and pulse wave amplitude during inspiration

Answer 13

Paradoxical pulse

Question 14

Paradoxical rise in jugular venous pressure (JVP) on inspiration

Answer 14

Kussmaul’s sign

Question 15

Pericarditis is a ________ presentation

Answer 15

chronic

Question 16

Elevated JVP withOUT paradoxical pulse WITH positive Kussmaul’s sign

Answer 16

Constrictive pericarditis

–> BOTH sides are constricted

Question 17

Tamponade is an _____ presentation

Answer 17

Acute

Question 18

Paradoxical pulse occurs in

Answer 18

tamponade

Question 19

Has no exaggeration in filling during inspiration

Answer 19

constrictive pericarditis